The US Supply Chain & Insulin

I heard a story on the news that the next US supply chain issue could be insulin. Their justification was that 3 companies control 90% of the supply.

How much insulin do you keep on hand at a time? I know our dosages vary from day to day and from person to person, but how much reserve do you keep?

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I re-order when I’m approaching a 1-month remaining supply. If I can’t get a refill in a month, and also can’t get the stopgap Regular insulin from Walmart, that says something about the world and my place in it. I have no desire to attempt survival during an End Of Civilization scenario.

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I cannot comment on how much is on hand since it is split into a few locations, but feel comfortable my son could survive a year or so without a refill. We take lots of trips to Canada.

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@Chris
Do you (your son) use all of every vial? Or do you just use a vial for 1 month and then use a new one? (I think the prescriptions say to dispose after 30 days.)

I’ve always used a vial until it’s gone, regardless of how long that takes, so it’s hard to estimate how long a vial will last.

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For the insulin vials I am currently using I keep about a 3 month reserve supply. My emergency reserve is a mish mash of Lantus, Tresiba, Humalog and Fiasp left over from years ago. Probably have enough there to last another 3 to 6 months, depending on whether it is all still good or not. (the Humalog is about 6 years old).

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I keep no reserve insulin supply, save for partially used vials of different insulin that I tried or used sometime in the past 5 years.

A new vial is as close as the nearest pharmacy, which are open 7 days a week :canada:

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Maybe you heard this? Compares it to the baby formula crisis.

I keep about 3-4 months on-hand.

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He uses all of every vial. We don’t buy into safe storage or expiration dates. He goes to college with the amount he needs for a semester and keeps it at room temp. No problems at all.

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I am like @Chris 's family. I keep my supply in multiple locations (fire season/power outages) and I have ~ a year or so extra with code dates current to +2 years. I use every bit of every vial, I don’t waste a drop, I could care less about an artificial expiration date.

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For those who keep a backup/reserve supply of insulin, how do you store it?

My daily vials (currently Novalog and Lantus) I keep at room temperature. But, my extras I keep refrigerated. I don’t know if that is necessary??

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Keeping your medication cold is a decent practice if you have access to a fridge that you trust, but honestly probably not needed for the 'log insulins (Humalog/Novalog). We haven’t really tested, nor have I seen data on the many basal insulins, other than to say they survive just fine at school.

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I keep my reserve extras in the fridge with date of purchase written on the box. I use a separate small camping fridge that has proven itself reliable. The brand is Dometic and it is dual voltage: 12V or 110V. Not much else fits in there besides the insulin.

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I do, too, but i hate to waste anything, that’s why I mostly use my omnipods for 80 hours, too.

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Same here…I use all insulin in vials/ pens, PODS are used up to the 80 hour mark and restart sensors each time (usually get an extra week on each one). I think my backup supply would last a year (keep unopened supply in the fridge but vials in use are always at room temp until gone).

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As a slight tangent but in keeping with the OP’s original topic. California announced in the 6/30/22 budget that they were getting into the insulin production game with an initial $100 M investment. $50 M would be earmarked for manufacturing facilities with the balance designated towards developing low cost biosimilar insulin products. Should be interesting to see what happens - success or boondoggle. Either way the big 3 insulin manufacturers are not going to like the competition, so most likely there will be some interesting legal wrangling ahead.

CNBC: California Insulin

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The legal wrangling will definitely be the issue. I see no reason they couldn’t set up a facility to create and process insulin for $50M, it will the patent litigation that will eat up the other $50M. If they win, that would be awesome because each state could set that up in the same way. If they lose, honestly $100M isn’t much in the California budget. I wish them luck.

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How about FDA approval? I think the median cost is 19 million. Even if the insulin is already approved the manufacturing, processing and packaging plants will have to meet FDA requirements.

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Honestly, I see it all as a show to strongarm the big 3 into submission. California has a lot of diabetics, many of which are insulin dependent. Given that Calif has on of the largest economies, why not try and force the “Insulin Oligarchy” into realistic pricing without all the hidden rebates, pbms, kickbacks, non-disclosures and the like.

The patents are expired on Humalog, Novolog and Lantus so making a biosimiliar should be cost effective in the long run given the population. Also if California decided to sell across state lines…

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Here’s a picture from “MarketRealist”, apparently another of murdoch’s hangers on, that summarizes the whole piece of bojo:

Here’s the article, if you really want to read something this bad.

The actual Rupert Murdoch article is utter garbage. Here is the “fact”, the one and only “fact” quoted verbatim from the original piece of dross:

The FDA announced just before the pandemic started, in February, 2020, that there was going to be a drug shortage including insulin due to the initial COVID outbreak in China.

I read the whole disgusting thing three times, I couldn’t find another fact relevant to the headline.

There is no link in the article to the FDA announcement. It dates from over two years ago, right at the start of the FDA awareness of COVID-19. Why is Murdoch quoting (or not) an FDA announcement from then? Maybe to push all the adverts for dubious stocks and dubious treatments in the rest of the article.

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California could also decide to openly work with OpenInsulin.org if their various business ideals aligned and outwardly, possibly, they do - inexpensive (read >$10/10ml vial) easily accessible insulin. OpenInsulin got started by a few biohackers back in 2015 who were fed up with fixed insulin pricing and started their own Banting based project in Oakland, CA. There has been a bunch of press over the years, but the best was a year or two ago in the New Yorker.

If California wants to jumpstart their $100M project, this might be one way to go if everyone’s values align, especially as OpenInsulin has a viable product ready for FDA submission already.

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